INTRADUCTAL PAPILLARY ADENOCARCINOMA WITH MUCIN HYPERSECRETION AND COEXISTENT INVASIVE DUCTAL CARCINOMA OF THE PANCREAS WITH APPARENT TOPOGRAPHIC SEPARATION
S. Miyakawa et al., INTRADUCTAL PAPILLARY ADENOCARCINOMA WITH MUCIN HYPERSECRETION AND COEXISTENT INVASIVE DUCTAL CARCINOMA OF THE PANCREAS WITH APPARENT TOPOGRAPHIC SEPARATION, Journal of gastroenterology, 31(6), 1996, pp. 889-893
We report a 66-year-old man who had a cystic intraductal papillary ade
nocarcinoma containing a papillary adenoma, in the head of the pancrea
s and a coexistent invasive, well differentiated solid tubular adenoca
rcinoma in the tail of the pancreas. He was hospitalized with acute ep
igastralgia. Computed tomography demonstrated a multilocular cystic ma
ss in the head of the pancreas and a solid tumor in the tail. Endoscop
ic retrograde pancreatography showed mucin secretion from an enlarged
papilla of Vater, marked dilatation of the main pancreatic duct in the
head and body, cystic dilatation of the uncinate branch, and irregula
r narrowing of the main pancreatic duct in the tail. Total pancreatect
omy was performed. Between the cystic tumor and the solid tumor there
was a distance of 4.8 cm of normal pancreatic parenchyma and duct, rec
ognized both grossly and microscopically. The patient died 35 months a
fter the operation. At autopsy, peritonitis carcinomatosa was found in
the abdominal cavity. Microscopically, disseminated nodules were also
well differentiated tubular adenocarcinoma. The apparent anatomic sep
aration of these two tumors within the pancreas is extremely unusual.